Global Family Doctor

WONCA is an unusual, yet convenient acronym comprising the first five initials of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians.

Professor Barbara Starfield championed the value and need of strong primary health care systems worldwide. This collection emphasizes the case for primary care and includes a number of Barbara Starfield's own articles as well as other key related material.

WONCA foundation award

The WONCA Foundation Award has been made possible by an initial donation of ten thousand Pounds Sterling from the Royal College of General Practitioners. This Award is made once every three years at the WONCA Council Meeting. The Award is to be used to further the aim of “fostering and maintaining high standards of care in general practice/ family medicine” by enabling physicians to travel to appropriate countries to instruct in general practice/ family medicine, and appropriate physicians from developing countries to spend time in areas where they may develop specials skills and knowledge in general practice/ family medicine.

At WONCA Cancun 2010, Dr David Whittet, of New Zealand, received the WONCA Foundation award. Dr Whittet has previously received the WONCA Foundation Award in 1998 and with his first award he worked to develop family medicine, in Orissa, in India.

Dr David Whittet - New Zealand

Delivering the inaugural Wesley Fabb Oration at the opening ceremony of the WONCA Asia Pacific Regional Conference in Kuala Lumpur, Malaysia, in 2002, Professor Fabb said, in regards to Dr Whittet, “Should we be concerned about the plight of general practitioners in India or Zimbabwe struggling to provide health care to a poor and often unappreciative population, under difficult economic and political circumstances? Often inadequately trained, short of supplies, poorly paid, overworked, harassed – should we care? Some do. New Zealander, David Whittet, went to Orissa State in India on a WONCA Foundation Award of just £1000 sterling and worked marvels. That can be repeated, if the motivation is there.”

Dr Whittet has the motivation to repeat his work in India and his 2010 award relates to a "Project to Develop Family Medicine in Rural Cambodia". Details of the work Dr Whittet undertook in India and his coming plans for Cambodia are outlined below.
1998 Award: Orissa, India
In 1998, Dr Whittet’s WONCA Foundation Award enabled him to develop family medicine in the Mayurbhanj region in rural Orissa, which was one of India’s poorest areas. Eighty per cent of the population in the project area were illiterate and below the absolute poverty level and there was a devastating under-five mortality of 300 per thousand, twice the rate for the rest of India.

Poor housing, lack of essential food and nutrition all played a large part, but polluted water proved to be the greatest cause of morbidity and mortality in the Mayurbhanj region. Leprosy and malaria were widespread. Traditional birth practices contributed to the devastating maternal and infant mortality figures.

His aim with the Orissa project was to help Indian colleagues develop an infrastructure for family medicine within their area, staffed and run by local family doctors. An essential goal was to have the project entirely self sufficient at the conclusion of the work. To be of lasting value, the project must enable the local family doctors to be independent and able to continue the project initiatives themselves.

Developing community clinics within each of the villages allowed the team to reach a maximum number of people with minimal set up costs.

The traditional birth attendants were a powerful group in the community with huge influence. It took diplomacy and determination to reach agreement with the birth attendants, but once achieved, maternal health improved significantly. Developing a childhood immunization program required much community consultation to make it appropriate to the specific needs of the project area and sensitive to the people’s beliefs.

Health education needs in the communities and schools were identified, as vital to promote self-awareness on health issues and preventable disease.

Dr Whittet believes the most significant contribution was to raise funds to build a well to provide safe, clean drinking water for all in the community. The project was also successful in developing a family medicine infrastructure to the Mayurbhanj region and was self sufficient at the conclusion in mid 2000. Setbacks did happen such as when they raised sufficient funds for a complete immunisation program for the project area, but local authorities refused permission to administer the vaccines to the children in the project communities. The message was clear: for a program to be implemented, protocols must be developed which are not just culturally sensitive to the local people but even more importantly, politically acceptable to the local authorities.

2010 Award: Project to Develop Family Medicine in Rural Cambodia

Dr Whittet’s 2010 proposal for a Cambodia project, builds on the aspects of the Orissa project which were most successful. As with the Orissa project, he sees it as fundamental that the project becomes self sufficient with a short space of time and is able to continue without further outside support. Shortly after publishing his Orissa work in the Australian Journal of Rural Health, Dr Whittet was approached by a professor of general practice in Cambodia about setting up a project in the Samrong Tong region of Cambodia, which is an area of extreme need with many similarities to the Mayurbhanj region.

Like Orissa, many of the scattered population are below the absolute poverty level. Many of the healthcare problems in Samrong Tong are remarkably similar to those of the Mayurbhanj region, but in a country with a quite different political history. A major challenge for the proposed project will be rebuilding trust and a sense of community amongst the people.

Dr Whittet’s role will be to help develop the infrastructure for family medicine, to provide support to the Cambodian professors and education and training to the young family physicians who will staff the project. Land-mines have devastated Cambodia. The project team hopes to work closely with those organisations committed to healing the legacy of land-mines. Medicine of Hope and Médecins Sans Frontières are the principal groups treating victims of land-mines. They also plan to work with area and village development committees and Rotary international to fund supplies of medicines and the building of wells.
For Dr Whittet, The Orissa project was a richly rewarding experience and he now hopes to makes a difference to this community in Cambodia, where the needs are equally urgent and extreme. He believes this project is another opportunity to further WONCA’s mission to improve the quality of life of the peoples of the world through fostering and maintaining high standards of care in general practice/family medicine.

Congratulations to Dr David Whittet of New Zealand - we look forward to hearing the outcome of his work in Cambodia.